POS0371 CAN WE ENHANCE ADHERENCE TO MEDICATIONS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS? RESULTS FROM A QUALITATIVE STUDY
Authors: S. Emamikia, C. Gentline, Y. Enman, I. Parodis
Journal: Annals of the Rheumatic Diseases (2022)

Background Medication non-adherence is common among patients with systemic lupus erythematosus (SLE) [1] and may lead to poor clinical outcomes [2,3]. Objectives Our aim was to identify influenceable contributors to medication non-adherence to suggest interventions that could increase adherence. Methods Patients with SLE from two Swedish tertiary referral centres (N=205) participated in a survey assessing self-reported adherence to medications. Medication adherence was self-reported and measured using the generic instrument Medication Adherence Self-Report Inventory (MASRI) and the rheumatic disease-specific instrument Compliance Questionnaire Rheumatology (CQR). Responses were used to select patients for qualitative interviews (N=15). Verbatim interview transcripts were analysed by two researchers using content analysis methodology. Results The mean age of the interviewees was 39 years, 87% were women, and their mean SLE duration was 11.6 years. Patients’ medications and adherence levels are detailed in Table 1. We categorised reasons for non-adherence thematically into (i) patient-related e.g., unintentional non-adherence due to forgetfulness or intentional non-adherence due to disbelief in medications, (ii) healthcare-related e.g., untrustworthy relationship with the treating physician, authority fear, and poor information about the prescribed medications or the disease, (iii) medication-related e.g., fear of side-effects, and (iv) disease-related reasons e.g., lacking acceptance of a chronic illness or perceived disease quiescence. Interventions identified that healthcare could implement to improve patients’ adherence to medications included (i) increased communication between healthcare professionals and patients, (ii) patient education, (iii) accessible healthcare, preferably with the same personnel, (iv) smooth transition from paediatric to adult care, (v) regularity in addressing adherence to medications, (vi) psychological support, and (vii) involvement of family members or people who are close to the patient. Table 1. Characteristics of the fifteen interviewees. Patient Prescribed medications Overall medication adherence according to: Intentional non-adherence (Y/N) MASRI (0–100%) CQR (0–100%) Direct question (Y/N) * 1 PRED 96 61 N Y HCQ 96 AZA 96 2 PRED 100 77 Y NA HCQ 100 MTX (pills) 100 3 PRED 100 81 Y NA 4 HCQ 90 58 N Y 5 HCQ 100 54 N Y 6 PRED 70 65 N N HCQ 70 AZA 69 7 PRED 67 47 N Y HCQ 50 AZA 20 8 HCQ 88 72 N N 9 PRED 95 74 N Y HCQ 96 MMF RTX (iv) 99 10 PRED 100 66 N N HCQ 100 AZA BEL (sc) 80 11 PRED 96 54 N N HCQ 100 MMF RTX 98 12 PRED 89 58 N N HCQ 92 13 PRED 100 84 Y NA CYS 100 14 HCQ 100 74 Y NA MTX (pills) 100 15 PRED 90 67 N N HCQ 90 MMF 80 1 MASRI: Medications Adherence Self Report Inventory; CQR: Compliance Questionnaire Rheumatology; F/M: female/male; Y/N: yes/no; NA: not applicable; iv: intravenous; sc: subcutaneous; PRED: prednisolone; HCQ: hydroxychloroquine; AZA: azathioprine; MTX: methotrexate; MMF: mycophenolate mofetil; RTX: rituximab; BEL: belimumab; CYS: cyclosporine; * Y= Adherence assent to direct question; N= Non-adherence assent to direct question. Conclusion The reasons for medication non-adherence are complex and multifaceted. From the patients’ perspective, multiple different strategies could be implemented in healthcare with the goal of improving adherence, including increased communication, patient education and psychological support. References [1]Mehat, P et al. Arthritis Care &amp; Research 2017, 69, 1706-1713. [2]Feldman, C.H. et al. Arthritis Care &amp; Research 2015, 67, 1712-1721. [3]Julian, L.J. et al. Arthritis and rheumatism 2009, 61, 240-246. Acknowledgements All authors would like to express our gratitude to the individuals who participated in the interviews and shared their thoughts, views, and opinions. Disclosure of Interests Sharzad Emamikia: None declared, Cidem Gentline: None declared, Yvonne Enman: None declared, Ioannis Parodis Grant/research support from: Amgen, AstraZeneca, Aurinia Pharmaceuticals, Elli Lilly and Company, Gilead Sciences, GlaxoSmithKline, Janssen Pharmaceuticals, Novartis and F. Hoffmann-La Roche AG.